Basic Information
| Provider Information | |||||||||
| NPI: | 1639567639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BITONG | ||||||||
| FirstName: | CELESTE | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1759 W GREENLEAF AVE | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928014026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147723860 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1720 W ORANGE AVE | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928042638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147761720 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2014 | ||||||||
| LastUpdateDate: | 12/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 27012 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.